Modified Oblique Keller Capsular Interposition Arthroplasty for Hallux Rigidus.

Introduction: This paper describes the modified oblique Keller capsular interposition arthroplasty, which may be indicated for patients with late-stage hallux rigidus who wish to retain joint motion.

Step 1 Exposure: Make dorsal medial longitudinal incision over MTP joint and retract dorsal cutaneous nerve of great toe laterally.

Step 2 Mobilize Extensor Hallucis Longus Tendon: Separate extensor hallucis longus from dorsal aspect of capsule and extensor hallucis brevis and retract laterally.

Patient compliance with clinical follow-up after total joint arthroplasty.

Background: Periodic clinical and radiographic evaluation is commonly recommended by orthopaedic surgeons to monitor patients following total joint arthroplasty, yet the compliance with and efficacy of patient follow-up protocols have not been well defined. The purpose of this study was to evaluate patient compliance with early clinical follow-up after total hip arthroplasty or total knee arthroplasty.

Methods: We performed a retrospective review of clinical follow-up compliance for 776 patients who had undergone a total joint arthroplasty in the lower extremity.

Timing of development of adjacent-level ossification after anterior cervical arthrodesis with plates.

Background Context: Although the prevalence and severity of adjacent-level ossification development after anterior cervical plating has previously been described, there are no investigations regarding the timing of ossification development.

Purpose: To determine the timing of adjacent-level ossification development and maturation and discern any differences in ossification development for patients who have a plate-to-disc distance (PDD) that is <5 mm versus =5 mm.

Study Design/setting: Retrospective study.

Anterior femoroacetabular impingement: a diverse disease with evolving treatment options.

Anterior femoroacetabular impingement (FAI) is a major etiologic factor in the pathogenesis of hip arthritis. In this condition, mechanical abnormalities of the hip joint lead to early hip dysfunction, inflammation, cartilage injury, and eventual joint degradation. FAI is now more commonly diagnosed and there is an increasing need for a thorough understanding of the broad spectrum of clinical presentation for the disease as well as more precise definition of the possible surgical options.

How to write a systematic review.

Evidence-based medicine (EBM) is the combination of the best available research evidence with clinical experience and patient needs. The concept of EBM as a part of clinical decision making has become increasingly popular over the last decade. In the hierarchy of studies meta-analysis and systematic reviews occupy the highest levels.

Calcium pyrophosphate dihydrate deposition disease (pseudogout) after total knee arthroplasty.

The authors report a case of calcium pyrophosphate dihydrate deposition disease (pseudogout) presenting in the early period after primary total knee arthroplasty. The patient's symptoms resolved with conservative management including colchicine and indomethacin. The presentation of pseudogout resembles septic arthritis and should be included in the differential diagnosis to prevent unnecessary surgery in these patients.

Arthrodesis techniques in the management of stage II and III acquired adult flatfoot deformity.

The proper management of acquired flatfoot deformity requires obtaining a careful patient history and physical examination of the foot, ankle, and lower extremity. Accurate assessment of foot flexibility and localization of pain will aid in decision making. Nonsurgical management may not be successful in patients with advanced disease, particularly with the development of degenerative changes.

Clinical presentation of patients with tears of the acetabular labrum.

Background: The clinical presentation of a labral tear of the acetabulum may be variable, and the diagnosis is often delayed. We sought to define the clinical characteristics associated with symptomatic acetabular labral tears by reviewing a group of patients who had an arthroscopically confirmed diagnosis.

Methods: We retrospectively reviewed the records for sixty-six consecutive patients (sixty-six hips) who had a documented labral tear that had been confirmed with hip arthroscopy.

Detection of esophageal perforation using intraesophageal dye injection.

Objectives: Esophageal perforation complicating anterior cervical spine surgery is a potentially fatal complication. Early identification and immediate treatment may lower adverse effects for the patient. The purpose of this study is to assess the efficacy of intraesophageal dye injection to detect an esophageal injury and to test two novel techniques.

Thymoglobulin induction is safe and effective in live-donor renal transplantation: a single center experience.

Background: The relative benefit versus safety of induction therapy in live-donor renal transplant recipients is controversial. This paper presents observational data of live-donor recipients who received Thymoglobulin induction and standard maintenance immunosuppressive therapy.

Methods: Review and analysis of clinic records and electronic databases of live-donor renal transplants that received Thymoglobulin induction from May 1996 through 2003.

Preliminary assessment and treatment guidelines for hip disorders in young adults.

The treatment of hip disorders in adolescents and young adults has evolved rapidly during the past decade because of enhanced understanding of prearthritic and early arthritic hip disease combined with improved diagnostic skills, better patient selection criteria, and refinements in alternative surgical procedures. Despite these advancements, the diverse clinical conditions and available surgical options highlight the need to develop optimal diagnostic and treatment guidelines for young patients with compromised hip function. Comprehensive care of young patients with hip disorders includes diverse surgical techniques such as arthroscopy, pelvic osteotomies, osteoplasty, femoral osteotomies, surgical dislocation, grafting procedures, arthrodesis, and prosthetic replacement.

Hypertrophy of ligamentum flavum in lumbar spinal stenosis associated with increased proteinase inhibitor concentration.

Background: It is well known that age-related fibrosis, or decreases in the elastin-to-collagen ratio of the ligamentum flavum, along with hypertrophy of the ligamentum flavum, are associated with lumbar spinal stenosis. However, the molecular mechanism by which this fibrosis and hypertrophy develop is unknown. Tissue inhibitors of matrix metalloproteinase (TIMPs) are proteinase inhibitors that suppress extracellular matrix degradation.

Normative values for thumb length, girth, and width in the pediatric population.

Purpose: To determine the normal relative length, girth, and nail width of the pediatric thumb with respect to the index finger in children ages 1 through 18 years.

Methods: Measurements of relative thumb length, girth, and nail width were performed on 546 hands in 273 volunteers ages 1 through 18 years. At least 22 hands were included for each age group.

Complications of fluoroscopically guided extraforaminal cervical nerve blocks. An analysis of 1036 injections.

Background: A number of serious complications associated with fluoroscopically guided extraforaminal cervical nerve blocks have been reported in the literature. The purpose of the present study was to determine the rate of complications associated with these blocks and to determine whether needle positioning during the procedure affected the prevalence of complications at one institution.

Methods: Between October 1999 and June 2003, we performed 1036 fluoroscopically guided extraforaminal cervical nerve blocks in 844 patients.

Development of adjacent-level ossification in patients with an anterior cervical plate.

Background: It has been our experience that ossification occurs adjacent to anterior cervical plates. Our hypothesis was that the closer the plate is to the adjacent disc space, the greater the ossification.

Methods: We retrospectively reviewed the lateral radiographs of the cervical spine of 118 patients who had a solid fusion following an anterior cervical arthrodesis with a plate for the treatment of a degenerative cervical condition; none of the patients had had cervical spine surgery prior to the index arthrodesis.

Periacetabular osteotomy for the treatment of severe acetabular dysplasia.

Background: The optimal treatment of severe acetabular dysplasia with subluxation of the femoral head or the presence of a secondary acetabulum remains controversial. The purpose of this study was to analyze the extent of surgical correction and the early clinical results obtained with the Bernese periacetabular osteotomy for the treatment of severely dysplastic hips in adolescent and young adult patients.

Methods: Sixteen hips in thirteen patients with an average age of 17.

Medial translation of the hip joint center associated with the Bernese periacetabular osteotomy.

This study assessed medial translation of the hip joint achieved by the Bernese periacetabular osteotomy (PAO) in correcting residual acetabular dysplasia deformities. 86 hips in 75 patients with an average age of 25 years (range, 12-50) were treated for symptomatic acetabular dysplasia with a periacetabular osteotomy. Radiographic analysis was performed to assess correction of the acetabular deformity with specific attention to the horizontal position of the hip joint center.

NF-kB signaling blockade abolishes implant particle-induced osteoclastogenesis.

In this study we investigated the effect of NF-kB signaling blockade on polymethylmethacrylate (PMMA) particle-induced osteoclastogenesis in vitro. We first established effective blockade of NF-kB activity as tested by electrophoretic mobility shift assays (EMSA). Particle-induced NF-kB activation in murine osteoclast precursor cells (CSF-1-dependent bone marrow macrophages) was markedly reduced by co-treatment of the cells with the NF-kB inhibitors N-tosyl-L-phenylalanine chloromethyl ketone (TPCK) and Calpain Inhibitor I (CPI).

Direct inhibition of NF-kappa B blocks bone erosion associated with inflammatory arthritis.

Inflammatory arthritis is associated with devastating joint tissue destruction and periarticular bone erosion. Although secreted products of infiltrating immune cells perpetuate the inflammatory response, the osteolytic component of this disease is a direct result of localized recruitment and activation of osteoclasts. Given that NF-kappaB plays a central role in both processes, the function of this transcription factor was examined.

The rediscovery and isolation of TFPI.

Tissue factor pathway inhibitor (TFPI) is a multivalent Kunitz-type proteinase inhibitor that produces factor (F)Xa-dependent feedback inhibition of the factor VIIa/tissue factor (FVIIa/TF) catalytic complex that is responsible for the initiation of coagulation. Since 1985, when Rapaport and colleagues reported that the lipoprotein fraction of plasma contained a FXa-dependent inhibitor of FVIIa/TF, myriad articles have established its biochemical structure, its mechanism of action, and its physiological importance. This brief personal account reviews historical studies that established the existence of the inhibitor and the events that led to its initial isolation.

Ulnar and median nerve palsy in long-distance cyclists. A prospective study.

Background: Although case reports have identified the presence of distal ulnar nerve sensory and motor dysfunction in long-distance cyclists, the actual incidence of this condition, referred to as "cyclist's palsy," is unknown.

Purpose: To determine the incidence of distal ulnar nerve compression in cyclists.

Study Design: Prospective study.

Two-portal repair of canine flexor tendon insertion site injuries: histologic and immunohistochemical characterization of healing during the early postoperative period.

Purpose: In vivo animal studies have indicated that the complex structure of the tendon-bone interface may not be restored after repair even under optimal conditions. Controversy exists about the histologic findings in the early postoperative period after tendon reattachment to bone; this may have impact on biomechanical properties. The objective was to study the histologic structure and immunohistochemical staining of the tendon-bone interface in a large model of digital flexor tendon-bone repair.

Neovascularization of the flexor digitorum profundus tendon after avulsion injury: an in vivo canine study.

Purpose: The changes in matrix material properties and intrinsic vascularization that have been noted in intrasynovial tendon stumps after avulsion injury may be of considerable clinical relevance with regard to the results of surgical repair. Our objective was to determine both the time course and the source of neovascularization of the tendon stump in an in vivo canine model of flexor digitorum profundus (FDP) avulsion after a clinically relevant delay in diagnosis.

Method: The FDP tendon was released from bone directly by sharp dissection and the vinculum brevis profundus was lacerated, simulating an avulsion injury with interruption of the vascular supply to the tendon stump.

Arthroscopic treatment of post-traumatic elbow contracture.

The purpose of this study was to evaluate range of motion and patient-reported outcome after complete arthroscopic release of post-traumatic elbow contracture. Fourteen consecutive patients who underwent elbow arthroscopy and capsular release were reviewed retrospectively at a minimum follow-up of 1 year. Pain and range of motion were measured.